Cornerstone of Accurate Medical Coding
Aug 27, 2015 | VIA BLOG | Posted 4:31 PM by Dr. Jon Elion

So, do you query a physician even if the answer would only impact a quality measure, and not reimbursement?

It is disquieting to know that in a recent survey by the Association of Clinical Documentation Improvement Specialists (ACDIS), only 75% of the 248 respondents report that they queried this way. This should be 100%.

It would be interesting in future surveys to find out the reasons underlying this result, as this may reflect an opportunity to education hospital executives on the importance of full and complete documentation and a comprehensive CDI program.

It is also interesting (albeit unsettling) that nearly 38% of 237 the ACDIS respondents report that reviewing for quality measures hinders their traditional CDI chart review productivity. This too suggests some opportunities for further clarifications in future surveys.

How is productivity being measured, as there are many potential metrics that have been suggested, such as the number of reviews, number of queries, improved reimbursements, increase in severity of illness, etc. The response to this survey question also suggests many programs feel working on behalf of solidifying quality measures is not part of “traditional CDI chart review” when in fact it should be.

The following list summarizes some of the activities related to providing the best environment and data for quality measures, including:

  • Educating hospital executive on the need to consider all aspects of documentation, not just those that directly impact reimbursement;
  • Carefully documenting conditions that are Present on Admission (“POA”), as failure to do so may have a significant negative impact on quality measures;
  • Designing and running a CDI program that emphasizes a full and complete chart, not just what is needed for reimbursement. Remember that many conditions may impact Risk of Mortality (the “Expected” part of the O/E ratio) without directly impacting reimbursement;
  • Fully documenting all conditions and comorbidities,
  • Implementing periodic code reviews and audits to ensure accurate and complete coding of the information on the chart; and
  • Making sure that there is adequate documentation (not just orders) regarding do-not-resuscitate (“DNR”) and palliative care status. These are not yet fully incorporated into all quality measures, but are being studied and will start to show up soon, so we might as well get in the habit of doing it now. There are specific codes for DNR (V49.86 for ICD-9 and Z66 for ICD-10) and for palliative (“comfort”) care (V66.7 for ICD-9 and Z51.5 for ICD-10).

The CDI field has seen a gradual change from reviews and queries done only after discharge to where they are now done concurrently during the hospital stay. Quality Measures are also poised to make a similar transition, as we strive to know not only how we were doing six months ago, but how we were doing six minutes ago.  This will in turn allow a hospital to focus on improving the quality of care while the patient is still in the hospital, resulting in better outcomes.

All of this is driven by a high-quality CDI program that is concerned about more than reimbursements, and is motivated to develop a complete medical record.  And at the end of the day, isn’t better quality and better patient outcomes the goal?

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